09/13 Blackie AMPS 202; +1 215; PMPS 351
- Thread starter Angela & Blackie & 3 Others
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Pat+Raja+Shadow (GA)
Member Since 2009
Re: 09/13 Blackie AMPS 202; +1 215
Nice numbers for Blackie this morning! :thumbup
Blackie is really doing very well Angela!! :razz:
I just saw your post added to yesterday's condo....I understand how you feel with the lower numbers. Now that Blackie is doing well, perhaps you will post the number first and someone will walk you through shooting at lower numbers. this WILL come up because Blackie is doing great...so it is something that will need to be worked on. I remember how i felt at first with the lower numbers after seeing such highs previously.It is scary at first, especially if you are not going to be home.
Shooting a reduced dose is sometimes the way to go...but sometimes it will hamper the good progress that has been made.
When you get a lower-than-usual number, you will be asked if you will be home for the next few hours, whether you have HC gravy and plenty of test strips too....those factors influence the dosing when you get a lower number.
If you get a lower PS, do not feed right away...but post the number here and ask for help in your header. People will ask you about th above and will talk to you about your choices of shooting.
I see that you shot 8.0u that first day on your SS...that is a LOT of insulin!!! And it was not Lantus at the time, correct? I think you have the tools now..you are on half that amount of insulin now and you have so much more going for you now. True hypos are scary, no doubt about it! but LOW numbers while using Lantus are totally different. BG testing is important and is the best tool for preventing radical drops. With the HC grvy and your meter, you will be able to handle the lower numbers just fine if you ask for help. We are here so please post and we will help...What do you think?
Nice numbers for Blackie this morning! :thumbup
Blackie is really doing very well Angela!! :razz:
I just saw your post added to yesterday's condo....I understand how you feel with the lower numbers. Now that Blackie is doing well, perhaps you will post the number first and someone will walk you through shooting at lower numbers. this WILL come up because Blackie is doing great...so it is something that will need to be worked on. I remember how i felt at first with the lower numbers after seeing such highs previously.It is scary at first, especially if you are not going to be home.
Shooting a reduced dose is sometimes the way to go...but sometimes it will hamper the good progress that has been made.
When you get a lower-than-usual number, you will be asked if you will be home for the next few hours, whether you have HC gravy and plenty of test strips too....those factors influence the dosing when you get a lower number.
If you get a lower PS, do not feed right away...but post the number here and ask for help in your header. People will ask you about th above and will talk to you about your choices of shooting.
Angela & Blackie & 8 Others said:
I see that you shot 8.0u that first day on your SS...that is a LOT of insulin!!! And it was not Lantus at the time, correct? I think you have the tools now..you are on half that amount of insulin now and you have so much more going for you now. True hypos are scary, no doubt about it! but LOW numbers while using Lantus are totally different. BG testing is important and is the best tool for preventing radical drops. With the HC grvy and your meter, you will be able to handle the lower numbers just fine if you ask for help. We are here so please post and we will help...What do you think?
Laurie and Mr Tinkles
Member Since 2010
Re: 09/13 Blackie AMPS 202; +1 215
Angela, Blackie is doing SO well! I know it's a little scary seeing lower numbers than you are used to, but you will learn how to handle them by following the advice Pat and Libby and other experienced people are giving you. They will walk you through it, you don't need to understand everything right away. It's another learning curve, and you have to take it a step at a time...you can do it, let others help you! I had to do the same thing, post and ask for help, let others walk me through the lower numbers...I didn't understand it either! I never thought I would shoot a full dose on a PS of 78, but that's exactly what I did this morning without hesitation...because I know I have the tools to handle it. You will get there too! :YMHUG:
Angela, Blackie is doing SO well! I know it's a little scary seeing lower numbers than you are used to, but you will learn how to handle them by following the advice Pat and Libby and other experienced people are giving you. They will walk you through it, you don't need to understand everything right away. It's another learning curve, and you have to take it a step at a time...you can do it, let others help you! I had to do the same thing, post and ask for help, let others walk me through the lower numbers...I didn't understand it either! I never thought I would shoot a full dose on a PS of 78, but that's exactly what I did this morning without hesitation...because I know I have the tools to handle it. You will get there too! :YMHUG:
Jill & Alex (GA)
Member Since 2009
Re: 09/13 Blackie AMPS 202; +1 215
blackie's showing such a nice response! you're really making some great progress here! now that she's showing us more blues, we should probably talk about a few things which probably weren't too important before, but they could be now.
your concern about hypos is real and one we all share. i can only imagine how scary it was to see a 21 on your meter back when harley was on 8u of prozinc! i can't blame you for being a little gun shy of lower numbers... even when they're "normal" double digits.
most kitties are started on a very low dose of lantus or levemir and worked up in a very systematic and methodical manner... like what you've been doing with blackie. the reason for that is to keep kitty safe. safety is our number one priority!
now that blackie is seeing numbers in the 100s, it becomes more important than ever to hold the dose for at least 6 consecutive cycles before increasing the dose. if a shot is skipped or a reduced dose is shot, the cycle count starts all over. this is important. harley needs at least 6 cycles on a dose for us to see how low the dose is taking is taking her. after all, lantus/levemir dosing is all about nadirs with only some consideration given to preshot numbers. if you jump the gun by increasing the dose, you might be surprised with an unexpected low number.
when presented with a preshot number lower than usual the best option is to be able to shoot blackie's regular dose on time. however, if you won't be around to monitor the cycle or the number is too low (below 50) there are 3 options commonly used in LL:
sometimes, taking one of these options is absolutely necessary, but you want to avoid all 3 whenever possible because:
why is it better to shoot a full dose on time as long as the preshot number is over 50 AND you'll be available to monitor?
simply put, lantus is a cumulative insulin. what you do today will effect the numbers over the next several days. the effects of stalling, reducing the dose, or skipping a shot may not be seen immediately (remember lantus has a shed/insulin depot), but you will see the effects in subsequent cycles.
in a sense, stalling, reducing, or skipping will set you back... and who wants to be set back when you've worked so hard to get to the point you're at! however, if one cannot monitor the cycle, it's better to take a set back in the name of safety! worry about getting back on track later. if you have a lower than usual preshot number, please post and someone will be happy to talk you through the process.
so, how do i become more comfortable shooting on lower preshot numbers?
by becoming "data ready".
the STICKY: LANTUS & LEVEMIR - DATA READY TO SHOOT LOW NUMBERS? talks about the "forgotten" or "neglected" spot checks...
those +1s, +2s, +10s, and +11s:
"Say you get a preshot of 150. Well if you've collected the data on the average time it takes the insulin to start having any effect for your cat and what happens after +12, then you might see that shooting a 150 is actually very safe in your cat. Kitty will be in the 200's before the insulin starts working. You are then using the lag time (aka overlap and carryover) between shooting and effect time to your advantage.
So why the +10's and +11's? Well say you are on day 5 of a dose increase change and your storage shed is now not only full, it is overflowing... and your +10 or +11 was way higher than your preshot. Good way to stay out of trouble cause now you know you would have shot a still dropping number, not a good idea. so what is the plan then?.... keep testing, and not 2 hours later, every 20-30 minutes would be better, so you can catch the minute it turns and do not loose all your overlap. If you miss the rise and cat is way up there BG wise before you shoot, remember the number is just going to continue to rise in those hours before the insulin has a chance to kick in, and you have a roller coaster curve going rather than the flat curve that is ideal.
Also some Lantus and Levemir users notice a dip at the end of the cycle, meaning that their preshot is always a bit lower than their +10 or +11. It is important to know if your cat is one of those because if you are not raising your dose because your PS doesn't seem to call for it, yet your nadir is not so hot... this could be the reason why."
these "forgotten" spot checks will yield more information than most realize.
ok, so i polished up my BOS, took a deep breath, and shot a full dose on the lowest preshot number i've yet to see. now what?
get those early spot checks... the +1 and +2, for sure. why? because the +1 *should* be higher than the ps number (food spike). the +2 *should* be about the same as the ps number. if they're not, that's your clue to monitor more closely than usual. depending on the cat (ECID) you may even want to feed a little bit to slow the drop. the first few times you go through this, i encourage you to post for guidance. there is always someone around who has "been there, done that" and will be happy to guide you through.
it's necessary to go back to the concept of lantus being a cumulative insulin. each dose builds upon the next. when i analyze numbers i see waves of action spanning several days. the ups and downs of these waves can be harsh until kitty approaches a dose break through dose. some kitties react more strongly than others. time and insulin usually flattens them out.
just a suggestion...
visit other condos where peeps are dealing with low numbers. you can learn a lot by seeing how others are advised to handle such situations. studying the spreadsheets of otj kitties and of those offering you suggestions and/or advice will help, too.
sorry for the length. if you have questions, please ask.
blackie's showing such a nice response! you're really making some great progress here! now that she's showing us more blues, we should probably talk about a few things which probably weren't too important before, but they could be now.
your concern about hypos is real and one we all share. i can only imagine how scary it was to see a 21 on your meter back when harley was on 8u of prozinc! i can't blame you for being a little gun shy of lower numbers... even when they're "normal" double digits.
most kitties are started on a very low dose of lantus or levemir and worked up in a very systematic and methodical manner... like what you've been doing with blackie. the reason for that is to keep kitty safe. safety is our number one priority!
now that blackie is seeing numbers in the 100s, it becomes more important than ever to hold the dose for at least 6 consecutive cycles before increasing the dose. if a shot is skipped or a reduced dose is shot, the cycle count starts all over. this is important. harley needs at least 6 cycles on a dose for us to see how low the dose is taking is taking her. after all, lantus/levemir dosing is all about nadirs with only some consideration given to preshot numbers. if you jump the gun by increasing the dose, you might be surprised with an unexpected low number.
when presented with a preshot number lower than usual the best option is to be able to shoot blackie's regular dose on time. however, if you won't be around to monitor the cycle or the number is too low (below 50) there are 3 options commonly used in LL:
- stall -- do NOT feed and retest in 15 - 30 min. repeat until you see that numbers are rising or you have a solid surf.
- shoot a BCS (big chicken sh*t) dose. this is a reduced dose.
- skip the shot.
sometimes, taking one of these options is absolutely necessary, but you want to avoid all 3 whenever possible because:
- stalling -- depletes the shed/insulin depot. the downside is that it may throw your schedule off since the next shot will be due 12 hours from whenever you eventually shoot. keep in mind, whenever you eventually shoot, it will take a couple of hours for onset to occur (the length of time before insulin reaches the bloodstream & begins lowering blood glucose). you will lose the effects of carryover (insulin effects lasting past the insulin's official duration) and overlap (the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect).
- shooting a BCS dose -- depletes the shed. carryover and overlap is lost, same as above. sometimes, shooting a BCS dose can give you a false sense of security because you *could* still see the residual effects remaining from the higher dose at work.
- skipping the shot -- depletes the shed, carryover and overlap are lost. it may take several cycles to get back to the point you were at.
why is it better to shoot a full dose on time as long as the preshot number is over 50 AND you'll be available to monitor?
simply put, lantus is a cumulative insulin. what you do today will effect the numbers over the next several days. the effects of stalling, reducing the dose, or skipping a shot may not be seen immediately (remember lantus has a shed/insulin depot), but you will see the effects in subsequent cycles.
in a sense, stalling, reducing, or skipping will set you back... and who wants to be set back when you've worked so hard to get to the point you're at! however, if one cannot monitor the cycle, it's better to take a set back in the name of safety! worry about getting back on track later. if you have a lower than usual preshot number, please post and someone will be happy to talk you through the process.
so, how do i become more comfortable shooting on lower preshot numbers?
by becoming "data ready".
the STICKY: LANTUS & LEVEMIR - DATA READY TO SHOOT LOW NUMBERS? talks about the "forgotten" or "neglected" spot checks...
those +1s, +2s, +10s, and +11s:
"Say you get a preshot of 150. Well if you've collected the data on the average time it takes the insulin to start having any effect for your cat and what happens after +12, then you might see that shooting a 150 is actually very safe in your cat. Kitty will be in the 200's before the insulin starts working. You are then using the lag time (aka overlap and carryover) between shooting and effect time to your advantage.
So why the +10's and +11's? Well say you are on day 5 of a dose increase change and your storage shed is now not only full, it is overflowing... and your +10 or +11 was way higher than your preshot. Good way to stay out of trouble cause now you know you would have shot a still dropping number, not a good idea. so what is the plan then?.... keep testing, and not 2 hours later, every 20-30 minutes would be better, so you can catch the minute it turns and do not loose all your overlap. If you miss the rise and cat is way up there BG wise before you shoot, remember the number is just going to continue to rise in those hours before the insulin has a chance to kick in, and you have a roller coaster curve going rather than the flat curve that is ideal.
Also some Lantus and Levemir users notice a dip at the end of the cycle, meaning that their preshot is always a bit lower than their +10 or +11. It is important to know if your cat is one of those because if you are not raising your dose because your PS doesn't seem to call for it, yet your nadir is not so hot... this could be the reason why."
these "forgotten" spot checks will yield more information than most realize.
ok, so i polished up my BOS, took a deep breath, and shot a full dose on the lowest preshot number i've yet to see. now what?
get those early spot checks... the +1 and +2, for sure. why? because the +1 *should* be higher than the ps number (food spike). the +2 *should* be about the same as the ps number. if they're not, that's your clue to monitor more closely than usual. depending on the cat (ECID) you may even want to feed a little bit to slow the drop. the first few times you go through this, i encourage you to post for guidance. there is always someone around who has "been there, done that" and will be happy to guide you through.
angela, you're not alone. initially, this is perhaps one of the most difficult concepts for any of us to wrap our heads around.
it's necessary to go back to the concept of lantus being a cumulative insulin. each dose builds upon the next. when i analyze numbers i see waves of action spanning several days. the ups and downs of these waves can be harsh until kitty approaches a dose break through dose. some kitties react more strongly than others. time and insulin usually flattens them out.
just a suggestion...
visit other condos where peeps are dealing with low numbers. you can learn a lot by seeing how others are advised to handle such situations. studying the spreadsheets of otj kitties and of those offering you suggestions and/or advice will help, too.
sorry for the length. if you have questions, please ask.
Angela & Blackie & 3 Others
Member Since 2010
Thank you for the advice.
What I want to know is... I'm up at around 5:30 a.m., (used to be 5:00 a.m. but now am shooting at or close to 6:00 a.m. on the nose)... who's going to be up at that hour if I get a PS # below 120?
What I want to know is... I'm up at around 5:30 a.m., (used to be 5:00 a.m. but now am shooting at or close to 6:00 a.m. on the nose)... who's going to be up at that hour if I get a PS # below 120?
Jill & Alex (GA)
Member Since 2009
you're welcome! i kind of threw a lot at you. do you have any questions?
although, i believe miriam/putty and dyana/JD are often around. monique/spooky may be, too.
it would probably be a good idea to make it a point to visit other condos to see how others handle shooting on low preshot numbers besides getting yourself data ready to shoot on low preshot numbers. you should also get a good idea when onset and nadir occurs, as well as get an idea of how much duration blackie is getting.
today, i can look down the list and see gabby, binks, kasha, achilles, podo, rufus, ele's blackie, tray, mr. tinkles, tess, korbel, savannah, pat's shadow, curry, mocha, stu, kim's shadow, kiki, jen's oreo, and jake all had preshot numbers less than the 188 blackie had yesterday. pick out a few to follow everyday to learn how to handle low preshot numbers. in the meantime, we'll hope the next lower preshot number blackie has will be at pmps time. :mrgreen:
tonight is blackie's third consecutive cycle on 4.25u bid. you'll want to hold this dose for at least 3 more cycles before increasing again (unless she drops too low at nadir). good luck with it!
no doubt about, there are less people on the board at that hour... which makes things a little tougher.
although, i believe miriam/putty and dyana/JD are often around. monique/spooky may be, too.
it would probably be a good idea to make it a point to visit other condos to see how others handle shooting on low preshot numbers besides getting yourself data ready to shoot on low preshot numbers. you should also get a good idea when onset and nadir occurs, as well as get an idea of how much duration blackie is getting.
today, i can look down the list and see gabby, binks, kasha, achilles, podo, rufus, ele's blackie, tray, mr. tinkles, tess, korbel, savannah, pat's shadow, curry, mocha, stu, kim's shadow, kiki, jen's oreo, and jake all had preshot numbers less than the 188 blackie had yesterday. pick out a few to follow everyday to learn how to handle low preshot numbers. in the meantime, we'll hope the next lower preshot number blackie has will be at pmps time. :mrgreen:
tonight is blackie's third consecutive cycle on 4.25u bid. you'll want to hold this dose for at least 3 more cycles before increasing again (unless she drops too low at nadir). good luck with it!
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